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HOUSE BILL No. 1293

Citations Affected: IC 5-10; IC 27-8; IC 27-13; noncode.

Synopsis: Colorectal cancer testing. Requires the group self-insurance program for state employees and any contract under which a health maintenance organization (HMO) provides health care services to state employees to provide coverage for colorectal cancer examinations and laboratory tests. Requires a group accident and sickness insurance policy that is employer based to provide coverage for colorectal cancer examinations and laboratory tests. Requires a group HMO contract that is employer based to provide colorectal cancer testing as a covered service. Provides that the coverage or covered services must cover or include at least one test of a certain type over a certain period of time for an insured or enrollee who is: (1) at least fifty (50) years of age; or (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society. Provides that an insurers or an HMO is required only to offer to provide coverage or services for colorectal cancer screenings in the case of a group insurance policy or group HMO contract that is not employer based.

Effective: July 1, 2000.

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Ruppel, Welch, Ayres

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    January 11, 2000, read first time and referred to Committee on Insurance, Corporations and Small Business.
    January 18, 2000, reported _ Do Pass.

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PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
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    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

SOURCE: IC 5-10-8-7.7; (00)HB1293.1.1. -->     SECTION 1. IC 5-10-8-7.7 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 7.7. (a) As used in this section, "covered individual" means an individual who is:
        (1) covered under a self-insurance program established under section 7(b) of this chapter to provide group health coverage; or
        (2) entitled to services under a contract with a health maintenance organization (as defined in IC 27-13-1-19 ) that is entered into or renewed under section 7(c) of this chapter.
    (b) A:
        (1) self-insurance program established under section 7(b) of this chapter to provide health care coverage; or
        (2) contract with a health maintenance organization that is entered into or renewed under section 7(c) of this chapter;
must provide coverage for colorectal cancer examinations and laboratory tests for cancer for any nonsymptomatic covered

individual, in accordance with the current American Cancer Society guidelines.
    (c) For a covered individual who is:
        (1) at least fifty (50) years of age; or
        (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the coverage required by this section must meet the requirements set forth in subsection (d).
    (d) For a covered individual described in subsection (c), the coverage required by this section must provide at least:
        (1) one (1) fecal occult blood test per year plus one (1) flexible sigmoidoscopy every five (5) years;
        (2) one (1) colonoscopy every ten (10) years; or
        (3) one (1) double contrast barium enema every five (5) to ten (10) years.
    (e) The coverage required under this section may not be subject to dollar limits, deductibles, copayments, or coinsurance provisions that are less favorable to covered individuals than the dollar limits, deductibles, copayments, or coinsurance provisions applying to physical illness generally under the self-insurance program or contract with a health maintenance organization.
    (f) The coverage for colorectal cancer screening must be provided in addition to benefits specifically provided for x-rays, laboratory testing, or wellness examinations.

SOURCE: IC 27-8-14.8; (00)HB1293.1.2. -->     SECTION 2. IC 27-8-14.8 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]:
     Chapter 14.8. Coverage for Services Related to Colorectal Cancer Screening
    Sec. 1. (a) As used in this chapter, "accident and sickness insurance policy" means an insurance policy that:
        (1) provides at least one (1) of the types of insurance described in IC 27-1-5-1 , Classes 1(b) and 2(a); and
        (2) is issued on a group basis.
    (b) "Accident and sickness insurance policy" does not include a policy providing accident only, credit, dental, vision, Medicare supplement, long-term care, or disability income insurance.
    Sec. 2. As used in this chapter, "insured" means an individual who is entitled to coverage under an accident and sickness insurance policy.     Sec. 3. (a) Except as provided in subsection (g), an insurer shall provide coverage for colorectal cancer examinations and

laboratory tests for cancer for any nonsymptomatic insured, in accordance with the current American Cancer Society guidelines, in any accident and sickness insurance policy that the insurer issues in Indiana or issues for delivery in Indiana.
    (b) For an insured who is:
        (1) at least fifty (50) years of age; or
        (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the coverage required by subsection (a) must meet the requirements set forth in subsection (c).
    (c) For an insured described in subsection (b), the coverage required by subsection (a) must provide at least:
        (1) one (1) fecal occult blood test per year plus one (1) flexible sigmoidoscopy every five (5) years;
        (2) one (1) colonoscopy every ten (10) years; or
        (3) one (1) double contrast barium enema every five (5) to ten (10) years.
    (d) An insured may not be required to pay an annual deductible or coinsurance for the colorectal cancer examination and laboratory testing benefit that is greater than an annual deductible or coinsurance established for similar benefits under the accident and sickness insurance policy. If the policy does not cover a similar benefit, the deductible or coinsurance may not be set at a level that materially diminishes the value of the colorectal cancer examination and laboratory testing benefit required by this chapter.
    (e) Except as provided in subsection (g), the coverage that an insurer must provide under this chapter may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to the insured than the dollar limits, deductibles, or coinsurance provisions applying to physical illness generally under the accident and sickness insurance policy.
    (f) Except as provided in subsection (g), the coverage that an insurer must provide under this chapter is in addition to any benefits specifically provided for x-rays, laboratory testing, or wellness examinations.
    (g) In the case of insurance policies that are not employer based, the insurer is required only to offer to provide the coverage described in subsections (a) through (f) in a proposed accident and sickness insurance policy.

SOURCE: IC 27-13-7-17; (00)HB1293.1.3. -->     SECTION 3. IC 27-13-7-17 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY

1, 2000]: Sec. 17. (a) As used in this section, "colorectal cancer testing" means examinations and laboratory tests for cancer for any nonsymptomatic enrollee, in accordance with the current American Cancer Society guidelines.
    (b) Except as provided in subsection (g), a health maintenance organization issued a certificate of authority in Indiana shall provide colorectal cancer testing as a covered service under every group contract that provides coverage for basic health care services.
    (c) For an enrollee who is:
        (1) at least fifty (50) years of age; or
        (2) less than fifty (50) years of age and at high risk for colorectal cancer according to the most recent published guidelines of the American Cancer Society;
the colorectal cancer testing required by subsection (b) must meet the requirements set forth in subsection (d).
    (d) For an enrollee described in subsection (c), the colorectal cancer testing required by subsection (b) must include at least:
        (1) one (1) fecal occult blood test per year plus one (1) flexible sigmoidoscopy every five (5) years;
        (2) one (1) colonoscopy every ten (10) years; or
        (3) one (1) double contrast barium enema every five (5) to ten (10) years.
    (e) Except as provided in subsection (g), the colorectal cancer testing that a health maintenance organization must provide under this section may not be subject to a contract provision that is less favorable to an enrollee than a contract provision applying to physical illness generally under the health maintenance organization contract.     (f) Except as provided in subsection (g), the colorectal cancer testing that a health maintenance organization must provide under this section is in addition to services specifically provided for x-rays, laboratory testing, or wellness examinations.
     (g) In the case of coverage that is not employer based, the health maintenance organization is required only to offer to provide the colorectal cancer testing described in subsections (b) through (f) as a covered service under a proposed group contract providing coverage for basic health care services.

SOURCE: ; (00)HB1293.1.4. -->     SECTION 4. [EFFECTIVE JULY 1, 2000] (a) IC 5-10-8-7.7 , as added by this act, applies to a self-insurance program or a contract between the state and a health maintenance organization established, entered into, amended, or renewed after June 30, 2000.
    (b) IC 27-8-14.8 , as added by this act, applies to accident and

sickness insurance policies that are issued, delivered, amended, or renewed after June 30, 2000.
    (c) IC 27-13-7-17 , as added by this act, applies to health maintenance organization contracts that are entered into, amended, or renewed after June 30, 2000.
    (d) This SECTION expires July 1, 2004.